J Clin Neurol.  2006 Mar;2(1):1-11. 10.3988/jcn.2006.2.1.1.

Small Vessel Disease and Subcortical Vascular Dementia

• Kalaria RN
• Erkinjuntti T

• KMID: 2287698
• DOI: http://doi.org/10.3988/jcn.2006.2.1.1

Abstract

Atherothromboembolism and intracranial small vessel disease are considered to be the main causes of cerebrovascular injury, which may lead to cognitive impairment and vascular dementia (VaD). VaD appears to be the second most common type of dementia with prevalence estimates of 10-15%. Cortical or multi-infarct dementia and subcortical vascular dementia (SVD) are suggested to be the two main forms of VaD. The main clinical features of SVD comprise decreased motor performance, early impairment of attention and executive function with slowing of information processing. SVD results from lacunar infarcts or multiple microinfarcts in the basal ganglia, thalamus, brainstem and white matter and are associated with more than 50% of the VaD cases. White matter changes including regions of incomplete infarction are usually widespread in VaD but their contribution to impairment of subcortical regions is unclear. While most of VaD occurs sporadically only a small proportion of cases bear clear familial traits. CADASIL is likely the most common form of hereditary VaD, which arises from subcortical arteriopathy. SVD needs unambiguous definition to impact on preventative and treatment strategies, and critical for selective recruitment to clinical trials.

Keyword

Cerebrovascular disease; CADASIL; Cognitive impairment; Dementia; Ischaemia; Lacunes; Small vessel disease; Stroke

MeSH Terms

Automatic Data Processing
Basal Ganglia
Brain Stem
CADASIL
Dementia
Dementia, Multi-Infarct
Dementia, Vascular*
Executive Function
Infarction
Prevalence
Stroke
Stroke, Lacunar
Thalamus

Figure

• 

  Figure 1 Overlap of VaD and AD. Clinical diagnosis (A) criteria predict overlap of 20-30% whereas autopsy findings (B) suggest a greater overlap where cases with mixed pathologies including cerebrovascular lesions and Alzheimer pathology up to Braak stage V are frequent. Several studies suggest this to be particularly true in the oldest old (i.e. >85 years old).

• 

  Figure 2 Pathological lesions associated with small vessel disease. A small infarct (arrow) and lacunes (arrowhead) in the basal ganglia of a 78 year old man with cognitive impairment. B and C, hyalinsed vessels with perivascular rarefaction and microinfarct in the white matter of a 78 year old man. Moderate gliosis in the surrounding region is also evident in both cases. Magnification Bar: A=2 cm; B, C=50 µm.

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